Substance use disorders (SUD) often co-occur with criminality, including violence, arrests, and incarceration\(^{[1; 2; 3; 4; 5]}\). People with polysubstance use (PSU) are considered a high-risk population, as they are associated with mortality, relapse, and contact with the criminal justice system (CJS)\(^{[6; 7; 8; 9; 10]}\). Although completing SUD treatment is linked with better outcomes, including preventing contact with CJS, the role of treatment completion in the link between PSU and contact with CJS is unclear\(^{[11; 12; 13; 14]}\). Studies have found mixed evidence regarding the association between PSU and treatment completion rates\(^{[15; 16; 17; 18; 19]}\). Thus, it is crucial to determine the role of treatment completion in order to improve outcomes in people with PSU. However, analyzing the role of treatment outcomes in people with PSU is challenging, as there is limited research on this population in Latin America, and high-risk populations have often been overlooked\(^{[20; 21; 22; 23; 24]}\).
Estimate the mediating effects of completing SUD treatment on the relationship between PSU at admission and contact with CJS among adult patients admitted to SUD treatment programs in Chile during 2010-2019. Specific: (1) To describe the prevalence of PSU, treatment completion, and contact with CJS in the sample, (2) to compare the risk of contact with CJS between people with poly and single-substance use, and (3) to estimate the proportion of the effect of PSU and treatment outcome on the contact with CJS.
This research design is a retrospective cohort based on the administrative data’s record linkage. The study will use data from Chilean SUTs programs and Prosecutor’s Office through a deterministic linkage process. We will request an amendment to an existing ethical approval from a study using the same data.
Exposure: baseline PSU (using more than one main substance among alcohol and illicit drugs at admission to SUD treatment, whether sequential or concurrent); Mediator: SUD treatment outcome (complete vs. dropout or spelled by misconduct); Outcome: contact with CJS (offense that led to a condemnatory sentence).
Figure 1: Covariate balance
Figure 2: Multistate scheme
We calculated the Aalen-Johansen estimator for transition probabilities at 6 months, 1 and 3 years using the multistate Stata command\(^{[26]}\). Secondary analyses focused on mediation, estimating the effects of PSU given treatment outcome at 6 months, 1 and 3 years using a standard time-to-first-event approach. Proportions mediated were estimated using the bootstrap method or m-estimation of standard errors on standardized survival curves and restricted mean survival times (RMST) through the stpm2 and stipw Stata commands\(^{[27; 28; 29; 30]}\). We also plan to run separate analyses on patients admitted to different treatment settings. Preliminary markdowns are available on: https://fondecytacc.github.io/nDP/an_ser_2023_step_0.html.
[1] A. A. Duke, K. M. Z. Smith, L. M. S. Oberleitner, et al. “Alcohol, drugs, and violence: A meta-meta-analysis.”. In: Psychology of Violence 8.2 (mar.. 2018), pp. 238–249. ISSN: 2152-081X. DOI: 10.1037/vio0000106.
[2] N. F. Sugie and K. Turney. “Beyond Incarceration: Criminal Justice Contact and Mental Health”. In: American Sociological Review 82.4 (ago.. 2017), pp. 719–743. ISSN: 0003-1224. DOI: 10.1177/0003122417713188.
[3] E. G. Thomas, M. J. Spittal, F. S. Taxman, et al. “Association between contact with mental health and substance use services and reincarceration after release from prison”. In: PLOS ONE 17.9 (sept.. 2022), p. e0272870. ISSN: 1932-6203. DOI: 10.1371/journal.pone.0272870.
[4] Y. Liu, V. Williamson, B. Setlow, et al. “The importance of considering polysubstance use: lessons from cocaine research”. In: Drug and Alcohol Dependence 192 (nov.. 2018), pp. 16–28. ISSN: 03768716. DOI: 10.1016/j.drugalcdep.2018.07.025.
[5] J. P. Connor, M. J. Gullo, A. White, et al. “Polysubstance use”. In: Current Opinion in Psychiatry 27.4 (jul.. 2014), pp. 269–275. ISSN: 0951-7367. DOI: 10.1097/YCO.0000000000000069.
[6] L. Gjersing and A. L. Bretteville-Jensen. “Patterns of substance use and mortality risk in a cohort of ‘hard-to-reach’ polysubstance users”. In: Addiction 113.4 (abr.. 2018), pp. 729–739. ISSN: 09652140. DOI: 10.1111/add.14053.
[7] A. N. Hassan and B. Le Foll. “Polydrug use disorders in individuals with opioid use disorder”. In: Drug and Alcohol Dependence 198 (may.. 2019), pp. 28–33. ISSN: 03768716. DOI: 10.1016/j.drugalcdep.2019.01.031.
[8] L. Wang, J. E. Min, E. Krebs, et al. “Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users”. In: International Journal of Drug Policy 49 (nov.. 2017), pp. 32–40. ISSN: 09553959. DOI: 10.1016/j.drugpo.2017.07.009.
[9] L. Quek, G. C. K. Chan, A. White, et al. “Concurrent and Simultaneous Polydrug Use: Latent Class Analysis of an Australian Nationally Representative Sample of Young Adults”. In: Frontiers in Public Health 1 (2013). ISSN: 2296-2565. DOI: 10.3389/fpubh.2013.00061.
[10] J. A. Ford, K. Ortiz, T. S. Schepis, et al. “Types of criminal legal system exposure and polysubstance use: Prevalence and correlates among U.S. adults in the National Survey on Drug Use and Health, 2015–2019”. In: Drug and Alcohol Dependence 237 (ago.. 2022), p. 109511. ISSN: 03768716. DOI: 10.1016/j.drugalcdep.2022.109511.
[11] W. White. Recovery/remission from substance use disorders: an analysis of reported outcomes in 415 scientific reports, 1868–2011. 2012. mar.. 14, 2023. URL: https://www.naadac.org/assets/2416/whitewl2012_recoveryremission_from_substance_abuse_disorders.pdf (visited on 03/14/2023).
[12] H. W. Andersson, M. Wenaas, and T. Nordfjærn. “Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances”. In: Addictive Behaviors 90 (mar.. 2019), pp. 222–228. ISSN: 03064603. DOI: 10.1016/j.addbeh.2018.11.008.
[13] K. P. Rezai-Zadeh, R. N. Engstrom, A. Sharma, et al. “Generational trends and patterns in readmission within a statewide cohort of clients receiving heroin use disorder treatment in Maryland, 2007–2013”. In: Journal of Substance Abuse Treatment 96 (2019), pp. 82–91. ISSN: 0740-5472. DOI: https://doi.org/10.1016/j.jsat.2018.10.010. URL: https://www.sciencedirect.com/science/article/pii/S0740547218301399.
[14] C. Timko, A. Nash, M. D. Owens, et al. “Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research”. In: Substance Abuse: Research and Treatment 14 (ene.. 2020), p. 117822181990128. ISSN: 1178-2218. DOI: 10.1177/1178221819901281.
[15] J. Levola, A. Aranko, and T. Pitkänen. “Psychosocial difficulties and treatment retention in inpatient detoxification programmes”. In: Nordic Studies on Alcohol and Drugs 38.5 (oct.. 2021), pp. 434–449. ISSN: 1455-0725. DOI: 10.1177/14550725211021263.
[16] N. G. Choi and D. M. DiNitto. “Older-Adult Marijuana Users in Substance Use Treatment: Characteristics Associated with Treatment Completion”. In: Journal of Psychoactive Drugs 52.3 (may.. 2020), pp. 218–227. ISSN: 0279-1072. DOI: 10.1080/02791072.2020.1745966.
[17] H. W. Andersson, A. D. F. Lauvsnes, and T. Nordfjærn. “Emerging Adults in Inpatient Substance Use Treatment: A Prospective Cohort Study of Patient Characteristics and Treatment Outcomes.”. In: European addiction research 27.3 (2021), pp. 206–215. ISSN: 1421-9891. DOI: 10.1159/000512156.
[18] H. W. Andersson, A. Steinsbekk, E. Walderhaug, et al. “Predictors of Dropout From Inpatient Substance Use Treatment: A Prospective Cohort Study”. In: Substance Abuse: Research and Treatment 12 (ene.. 2018), p. 117822181876055. ISSN: 1178-2218. DOI: 10.1177/1178221818760551.
[19] D. Basu, A. Ghosh, S. Sarkar, et al. “Initial treatment dropout in patients with substance use disorders attending a tertiary care de-addiction centre in north India”. In: Indian Journal of Medical Research 146.8 (2017), p. 77. ISSN: 0971-5916. DOI: 10.4103/ijmr.IJMR_1309_15.
[20] K. Lalwani, P. Whitehorne-Smith, G. Walcott, et al. “Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica”. In: BMC Psychiatry 22.1 (dic.. 2022), p. 513. ISSN: 1471-244X. DOI: 10.1186/s12888-022-04160-2.
[21] J. C. Reyes, C. M. Perez, H. M. Colon, et al. “Prevalence and Patterns of Polydrug Use in Latin America: Analysis of Population-based Surveys in Six Countries”. In: Review of European Studies 5.1 (feb.. 2013). ISSN: 1918-7181. DOI: 10.5539/res.v5n1p10.
[22] R. Santis B, C. G. Hidalgo C, V. Hayden C, et al. “Consumo de sustancias y conductas de riesgo en consumidores de pasta base de caca'ina no consultantes a servicios de rehabilitación”. In: Revista médica de Chile 135.1 (ene.. 2007). ISSN: 0034-9887. DOI: 10.4067/S0034-98872007000100007.
[23] C. F. Olivari, J. Gaete, N. Rodriguez, et al. “Polydrug Use and Co-occurring Substance Use Disorders in a Respondent Driven Sampling of Cocaine Base Paste Users in Santiago, Chile”. In: Journal of Psychoactive Drugs 54.4 (ago.. 2022), pp. 348–357. ISSN: 0279-1072. DOI: 10.1080/02791072.2021.1976886.
[24] F. Vilugrón, T. Molina G., M. E. Gras-Pérez, et al. “Precocidad de inicio del consumo de sustancias psicoactivas y su relación con otros comportamientos de riesgo para la salud en adolescentes chilenos”. In: Revista médica de Chile 150.5 (may.. 2022), pp. 584–596. ISSN: 0034-9887. DOI: 10.4067/s0034-98872022000500584.
[25] S. R. Cole and M. A. Hernan. “Constructing Inverse Probability Weights for Marginal Structural Models”. In: American Journal of Epidemiology 168.6 (jul.. 2008), pp. 656–664. ISSN: 0002-9262. DOI: 10.1093/aje/kwn164.
[26] M. J. Crowther and P. Lambert. MULTISTATE: Stata module to perform multi-state survival analysis. ene.. 2023. URL: https://econpapers.repec.org/RePEc:boc:bocode:s458207.
[27] L. A. Stefanski and D. D. Boos. “The Calculus of M-Estimation”. In: The American Statistician 56.1 (feb.. 2002), pp. 29–38. ISSN: 0003-1305. DOI: 10.1198/000313002753631330.
[28] T. J. VanderWeele. “Causal Mediation Analysis With Survival Data”. In: Epidemiology 22.4 (jul.. 2011), pp. 582–585. ISSN: 1044-3983. DOI: 10.1097/EDE.0b013e31821db37e.
[29] P. Lambert. STPM2: Stata module to estimate flexible parametric survival models. Statistical Software Components, Boston College Department of Economics. feb.. 2010. URL: https://ideas.repec.org/c/boc/bocode/s457128.html.
[30] M. Hill. “Development and application of methods in parametric survival models: interval censoring, inverse probability weighting and multistate survival models”. University of Leicester, 2022. URL: https://doi.org/10.25392/leicester.data.21533514.v1.